Background Malaria in pregnancy remains a leading cause of maternal and neonatal morbidity in sub-Saharan Africa. Insecticide-treated nets (ITNs) are a cornerstone preventive intervention, yet utilization among pregnant women remains suboptimal despite widespread distribution. Understanding the specific knowledge, socio-demographic, health system, and household-level factors that determine whether pregnant women use ITNs consistently is essential for designing effective targeted interventions. This study assessed these factors among pregnant women attending antenatal care (ANC) in the Kintampo North Municipality of the Bono East Region of Ghana. Methods A facility-based, descriptive cross-sectional study was conducted among 355 pregnant women attending ANC at three purposively selected health facilities in the Kintampo North Municipality. Participants were recruited consecutively using convenience sampling. Data were collected using a structured, interviewer-administered questionnaire covering knowledge of ITNs, socio-demographic characteristics, health system factors, and household-level factors. Knowledge was classified as good, fair, or poor. ITN use was classified as regular (sleeping under an ITN every or most nights) or irregular. Data were analyzed using Epi Info; chi-square tests assessed associations between independent variables and regular ITN use, with statistical significance set at p < 0.05. Results The majority of respondents (84.2%) demonstrated good knowledge of ITN use in pregnancy, while regular ITN utilization was reported by 67.6% indicating a significant knowledge–practice gap. A statistically significant association was found between knowledge level and regular ITN use (χ² = 9.59, df = 2, p = 0.01), with regular use highest among women with good knowledge (70.6%) and lowest among those with poor knowledge (20.0%). Among socio-demographic factors, only the number of ANC visits was significantly associated with ITN use (χ² = 13.71, p = 0.001): women with more than four visits had the highest regular usage (75.2%). No health system factor reached statistical significance, though women rating health worker education as excellent had the highest usage (74.0%) and those reporting consistent ITN supply had 5.0 percentage points higher usage. Among household factors, structural feasibility, having adequate physical space to hang an ITN — was the only significant predictor (χ² = 4.35, p = 0.037), with 68.7% regular use among women with sufficient space versus 50.0% among those without. Conclusions While knowledge of ITN use is high among pregnant women in the Kintampo North Municipality, a substantial knowledge–practice gap persists. ANC frequency and household structural feasibility are the key modifiable predictors of consistent use. Interventions should prioritize increased ANC attendance, ITN hanging infrastructure support at household level, and sustained supply chain reliability, alongside continued investment in high-quality health worker counselling during ANC visits. Keywords: insecticide-treated nets; ITN utilization; pregnant women; antenatal care; malaria prevention; knowledge–practice gap; Ghana; Kintampo North Municipality
Kabiri et al. (Sun,) studied this question.